Alteration to Hormonal function

Question 1

Explain homeostasis for normal blood glucose

Answer 1

Stimulus: High BSL

• high glucose level is detected by insulin- secreting cells (beta cells) in the pancreas
• Beta cells will stimulate the release of insulin in the blood
• Insulin attaches to insulin receptors in the cells opening up glucose channel
• Liver takes up excess glucose and stores it as Glycogen (Glycogenesis)
• BSL returns to normal

Stimulus: Low BSL

• low glucose level is detected by glucagon- releasing cells (alpha cells) in the pancreas
• Alpha cells will stimulate the release of glucagon in the blood targeting the liver
• Liver is triggered to breakdown glycogen into glucose to release into bloodstream
• BSL returns to normal

Question 2

a condition caused by autoimmune response
No insulin present to bring glucose into the cells
Usually diagnosed in childhood

Answer 2

T1 Diabetes

Question 3

In T1 diabetes, cells break down protein and fat for energy causing ketones to build up resulting in

Answer 3

Metabolic Acidosis

Question 4

Risk factors of T1 Diabetes

Answer 4

Genetics

Family Hx

Question 5

S&S of T1 diabetes

Answer 5

Onset 3Ps
Polyuria (excessive urination) - overwhelmed kidneys to filter hight amount of glucose resulting in glycosuria (glucose + urine)

Polydipsia (excessive thirst) - osmotic effect of the glucose draws water into the urine causing dehydration

Polyphagia (excessive hunger) - since glucose cannot metabolise by cells due to no insulin present, cells are deprived with nutrients resulting in cellular starvation and hunger (body reaction)

Question 6

Nursing intervention for T1 diabetes

Answer 6

Insulin (dependent for life)

No oral hypoglycemic agents will work

Question 7

Major complication of T1DM
Lack of insulin leading to lipolysis (breakdown of fats and proteins in the body for cellular metabolism)
Increased fatty acid levels (ketones) leads to Acidosis

Answer 7

DKA or Diabetic Ketoacidosis

Question 8

Causes of DKA

Answer 8

Stress
Sepsis
Skipping insulin
N&V
Undiagnosed diabetes

Question 9

S&S of DKA

Answer 9

Hyperglycaemia 
Ketosis and acidosis
Metabolic acidosis
Kussmaul respirations (laboured blowing off CO2)
Acid breath or fruity smell breath

Question 10

Nursing treatment for DKA

Answer 10

IV insulin with K+ 
Monitor K levels since insulin allows glucose and K+ inside the cells causing Hypokalaemia 
Fluid replacement
correction of electrolyte imbalance
Adm bicarbonate for metabolic acidosis

Question 11

S&S of hypoglycaemia

Answer 11

shakiness or dizziness
headache
fast and pounding HR
sweating, cold and clammy skin

Question 12

a condition caused by not producing enough insulin or produces bad insulin that does not work properly
caused by insulin resistance
insulin receptors are worn out
usually diagnosed in adulthood (due to poor diet, sedentary lifestyle and obesity)

Answer 12

T2 Diabetes

Question 13

Causes of T2DM

Answer 13

HTN
High BSL
Obesity 
Inactivity
High cholesterol
Family Hx
Smoking

Question 14

S&S of T2DM

Answer 14

Gradual 3 Ps (Polyuria, Polyphagia and Polydipsia)
Always tired
Sudden weight loss
Wounds that wont heal
Blurry vision
Numb or tingling hands or feet
Vaginal infections

Question 15

Nursing treatments for T2DM

Answer 15

Encourage healthy diet and exercise

Oral hypoglycaemic agents (Metformin)

Question 16

Organs affected by diabetes

Answer 16

High BSL can damage blood vessels and the nerves
KIDNEYS - (Nephropathy) excessive blood glucose can damage the filtering system (glomeruli) leading to kidney failure

NERVES - (Peripheral Neuropathy) excessive blood glucose can injure nerves causing tingling, numbness and eventually loss of sensation especially in the foot leading to infections in cuts and blisters. This can also delay wound healing and high risk of infection

EYES - (Diabetic Retinopathy) excessive blood glucose can damage blood vessels in the retina causing blindness, cataracts and glaucoma.

HEART - (CVD) excessive blood glucose can damage blood vessels (major coronary arteries) and nerves controlling the heart causing CAD, HTN and Atherosclerosis.

BRAIN - (Stroke) excessive blood glucose can damage and stiffen blood vessels and builds up fatty deposits causing blood clots which can travel to the brain and cause stroke.

Question 17

a condition in which a pregnant person cannot produce enough insulin which eventually develops

Answer 17

Gestational Diabetes

Question 18

Risk to Mother with gestational diabetes

Answer 18

increased chance of caesarean section to deliver a baby
increased chance of UTI
high risk of developing overt diabetes (T2DM) later in life

Question 19

Risk to baby carried by a person with gestational diabetes

Answer 19

Large at birth
shoulder dystocia 
extreme hypoglycaemia after birth
Prolonged new-born jaundice
Hypocalcemia
Respiratory distress syndrome

Question 20

Happens mostly in T2DM pts which no acidosis (ketones) is present just hyperglycaemia

Answer 20

Hyperglycaemic Hyperosmolar Nonketotic Syndrome (HHNS)

Question 21

Nursing intervention for HHNS (Hyperglycaemic Hyperosmolar Nonketotic Syndrome)

Answer 21

Adm IV insulin with K+ or SubQ insulin (Hyperglycaemia)
Fluid replacement (Dehydration)
Correction of electrolyte imbalance (decreased kidney function)

Question 22

2 Vascular related long term complications of T2DM

Answer 22

Macrovascular - CVD, PVD and peripheral neuropathy

Microvascular - Retinopathy, Nephropathy and Neuropathy